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UBC Theses and Dissertations

Stigma and confidentiality as barriers to uptake of HIV counseling and testing for health workers in 3 public hospitals in Free State province, South Africa : a mixed-methods study Khan, Rabia


Background: The HIV and AIDS epidemic has created a human resource crisis that “has replaced financial issues as the most serious obstacle to implementing national treatment plans” (WHO 2006a: 20). To retain the existing health workforce, international guidelines promote priority access to health services for health workers (HWs) through occupationally-based HIV counseling and testing (HCT) services. Such services have been implemented in South Africa (RSA), however recent evidence suggests their uptake is low. Objective: To identify barriers and facilitators to uptake of HCT services by HWs in three hospitals in Free State province, RSA. Methods: This mixed-methods study analyzed a portion of a self-administered survey and focus groups interviews (FGIs) to explore participants’ attitudes and behaviours related to HIV in the workplace, why HIV services may be underutilized and participants’ recommendations to improve the service. Results: In total, 978 HWs participated in the survey and 38 participated in the FGIs. Among survey respondents, 38.9% indicated a fear that confidentiality will not be maintained as the reason for not using OHS-based HIV services. 38.5% HWs perceive there is HIV stigma in the workplace. Six themes were identified from the FGIs, including location for testing, privacy, confidentiality, gossip, stigma and facilitators. FG participants perceived doctors’ and nurses’ experience with HIV in the workplace differs from other HWs, supported by multivariate analyses indicating patient-care HWs (PCHWs) have higher odds of perceiving confidentiality is not maintained in the OHS (adjusted ORs = 2.3; 95% CI 1.8-3.2) and perceiving HIV stigma in the workplace (adjusted OR = 2.4; 95% CI 1.8-3.2) when compared to non-PCHWs. FG participants also identified the need for in-service training on a range of topics related to HIV and expressed a desire to form HIV support groups to address negative attitudes toward HIV/AIDS in the workplace. Conclusions: Fear of breaches in confidentiality and HIV stigma were identified as the primary barriers to uptake of occupationally-based HCT by HWs. Overcoming these barriers require educating HWs on policies and guidelines that govern HIV in the workplace, implement measures to ensure confidentiality is maintained and addressing HIV stigma through stigma reduction interventions.

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